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Multimodal strategy in the successful implementation of a stroke unit in a community hospital
Author(s) -
Etgen T.,
Freudenberger T.,
Schwahn M.,
Rieder G.,
Sander D.
Publication year - 2011
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/j.1600-0404.2010.01413.x
Subject(s) - thrombolysis , medicine , stroke (engine) , community hospital , acute stroke , unit (ring theory) , emergency medicine , tissue plasminogen activator , psychology , nursing , mechanical engineering , mathematics education , myocardial infarction , engineering
Etgen T, Freudenberger T, Schwahn M, Rieder G, Sander D. Multimodal strategy in the successful implementation of a stroke unit in a community hospital.
Acta Neurol Scand: 2011: 123: 390–395.
© 2010 John Wiley & Sons A/S. Objectives – Thrombolysis in stroke remains underutilized in daily practice. We analyzed the impact of a multimodal strategy on the rate of thrombolysis and specific procedure times during the implementation of a community hospital stroke unit. Material and methods – During a period of 2 years before and after implementation of a stroke unit, we prospectively recorded all patients with thrombolysis and specific procedure times. Calculated door‐to‐needle time (DNT), door‐to‐CT time (DCT) and CT‐to‐needle time (CNT) were analyzed. All structural changes before and after the implementation were analyzed. Results – The number of patients with thrombolysis increased from 24 in 2005–2006 (4.8% of all admitted patients with ischemic stroke) to 95 in 2007–2008 (12.8%). DNT was significantly reduced from 62.2 ± 36.1 to 38.5 ± 22.2 min ( P < 0.001). DCT remained unchanged at 10.3 ± 9.5 to 10.4 ± 13.9 min ( P = 0.974), whereas CNT improved from 45.7 ± 23.1 to 28.3 ± 20.3 min ( P = 0.001). Several structural changes concerning staff, logistics, procedures and laboratory were identified which contributed to decreasing DNT. Conclusions – A multimodal strategy including several structural changes enables the successful implementation of a community hospital stroke unit offering rapid access to thrombolysis with a very short DNT.